As state budget discussions come to a close this month, New Jersey lawmakers and advocates alike should turn their attention to the ways that the American Rescue Plan (ARP) can complement the state’s Fiscal Year (FY) 2022 budget. The ARP, signed into law by President Biden in March, includes expansions to food assistance, housing support, unemployment benefits, tax credits for working families, and health coverage to ensure a full and strong recovery after the COVID-19 pandemic.
The ARP’s health investment presents big opportunities to complement work that state leaders and advocates are pursuing through the state budget. Governor Murphy’s proposed FY 2022 budget and the subsequent legislative discussions should put New Jersey on a path toward a strong recovery, reversing in many ways the state government’s policy approach coming out of the Great Recession. Programs like Cover All Kids, support for reproductive health care, and Medicaid coverage for doula services will begin to address many root causes of the health disparities that existed prior to the pandemic and worsened its devastation in the state.
Through the ARP, New Jersey can build on these state-led efforts with federal funding and support. The ARP funds a long list of health programs, including subsidies for health insurance through the state exchange, public health infrastructure, community health workers, mental health and substance use services, home and community-based services, postpartum care, Medicaid expansion, and more. While New Jersey already expanded Medicaid (and thus cannot receive the increased funds for its introduction) and implemented the increased subsidies through GetCovered NJ, there are still several outstanding opportunities for health-specific investments. If targeted effectively, these funds can solidify New Jersey’s path to a quick, strong, and equitable recovery. Here are four priorities for decision-makers and advocates to consider when planning for the use of these funds.
1. Avoid Band-Aid Fixes by Investing in Long-Lasting Infrastructure
State and local leaders may find it tempting to spend the ARP funds on temporary fixes. Yet crisis-response investments without a broader strategy do not address the need for stronger, permanent public health infrastructure. Critically, infrastructure should not only include traditional physical infrastructure; it must incorporate and prioritize human infrastructure, or support for those who provide key services. Without this, New Jersey cannot adequately combat the effects of COVID-19 and structural racism to better weather the next pandemic.
The ARP’s funds support infrastructure development that addresses the devastation the pandemic has had on mental health and substance use challenges, particularly for communities of color. The $78 million that New Jersey receives through the ARP’s Community Mental Health Services Block Grant (MHBG) and Substance Abuse Prevention and Treatment Block Grant (SABG) can fund such expansions. This includes, for example, increasing the number of facilities and available beds that provide treatment for behavioral health issues that center person-centered care, while also supporting a larger public health workforce dedicated to treatment at those facilities. Adequate support provides improved paths to training, credentials, and benefits to support workers’ physical and mental wellbeing.
2. Expand The Length and Diversity of Services for Those with the Greatest Need
Many New Jerseyans, particularly Black and Latinx/Hispanic residents, do not have access to culturally-competent health services that address rapidly changing lifestyles and approaches to care, let alone services that actively counteract the effects of structural racism. By expanding the supported services through the NJ FamilyCare — the state’s Medicaid program — New Jersey can better cover people who face health vulnerabilities, including those with postpartum care needs or living with disabilities. By addressing gaps in health care, the state will better protect those who are at the highest risk of illness and death during a pandemic.
The ARP’s state option to extend Medicaid coverage of postpartum care to 12 months from 60 days (which was also proposed by Governor Murphy in his February FY2022 budget) will help around 8,700 New Jersey women per year receive the care they need. New Jersey leaders have already submitted plans to the federal government for an extension to six months; these will automatically be updated to reflect the full-year expansion. Additionally, the ARP’s enhanced federal funding for Medicaid Home and Community-Based Services (HCBS), which could bring approximately >$172.7 million into New Jersey, can be invested in services that protect people before, during, and after crises, removing the scramble to transition when future outbreaks occur. These can include maintaining and building on telehealth services, expanding personal care services, and providing personal protective equipment (PPE) supplies to home and community health workers.
3. Ensure Investments in the Health Workforce Last Beyond the Crisis
The COVID-19 pandemic emphasized the importance of a diverse and sufficiently supported health workforce in protecting all residents of the Garden State. Community health workers, who are both public health workers and intermediaries between health services and communities, and Direct Support Professionals (DSPs), who provide care directly to individuals with disabilities through programs like Medicaid Home and Community-Based Services (HCBS), serve vital roles in bridging the gaps between the health care system and the unique needs of individuals and communities.
Despite initiatives to better integrate the work of CHWs and increase pay for DSPs, New Jersey remains behind other states in adequately supporting these essential workers. The state still has one of the lowest numbers of community health workers (CHW) compared to the total number of jobs in the state, a turnover rate for DSPs that remains above 40 percent, and dismal wages for services. Continuing to underfund diverse and essential care severely limits resources for people and communities with the greatest health challenges and exacerbates structural racism on health. New Jersey can improve the system of care throughout the state by: ensuring that CHW, DSP, and other essential health workers’ reimbursement adequately support their vital services; supporting training through programs like the Colette Lamothe-Galette (CLG) Community Health Worker Institute; and redesigning training to be flexible and address not just current, but also growing and anticipated health needs. In addition to the HCBS enhanced federal funding, the ARP provides several grant opportunities that New Jersey leaders should leverage to invest in long-term solutions.
4. Keep the Public Conversation Open: Don’t Make The Plan One and Done
Conversations with communities whom COVID-19 has disproportionately harmed will continue to play an essential role in determining the most helpful ways to address the pandemic’s devastation. With changing social and economic circumstances throughout the state and country, the discussions on how best to target funds cannot be held to one-and-done meetings. Instead, New Jersey can make the most of the ARP’s opportunities by implementing broad plans that allow flexibility to respond to feedback from individuals, families, and communities. Ensuring that communities’ needs are addressed will help overcome structural biases in aid and investment. Additionally, planning for regular evaluations of the funding’s impact — instead of treating the ARP as a standalone, single action — can help to better target funds and improve health outcomes for New Jersey’s future.